Intramuscular epinephrine as first-line treatment of anaphylaxis: Still concerns about its safety in the elderly

Anaphylaxis is a severe condition that can affect patients of all ages. Elderly patients must be considered particularly vulnerable to severe anaphylaxis due to many risk factors such as concomitant diseases and med- ications. Intramuscular administration of epinephrine is recommended as fist-line therapy for anaphylaxis and its use should be promoted in every setting. Intramuscular epinephrine is recognized as generally safe and there are no absolute contraindications to the prescription of self-injectable adrenaline in older patients at risk of anaphylaxis

Delirium and Clusters of Older Patients Affected by Multimorbidity in Acute Hospitals.

Objectives: Delirium is commonly seen in older adults with multimorbidity, during a hospitalization, resulting from the interplay between predisposing factors such as advanced age, frailty, and dementia, and a series of precipitating factors. The association between delirium and specific multimorbidity is largely unexplored so far although of potential key relevance for targeted interventions. The aim of the study was to check for a potential association of multimorbidity with delirium in a large cohort of older patients hospitalized for an acute medical or surgical condition. Design: This is a cross-sectional study nested in the 2017 Delirium Day project. Setting and participants: The study includes 1829 hospitalized patients (age: 81.8, SD: 5.5). Of them, 419 (22.9%) had delirium. Methods: Sociodemographic and medical history were collected. The 4AT was used to assess the presence of delirium. The Charlson Comorbidity index was used to assess multimorbidity. Results: The results identified neurosensorial multimorbidity as the most prevalent, including patients with dementia, cerebrovascular diseases, and sensory impairments. In light of the highest co-occurrence of 3 neurosensorial chronic conditions, we could hypothesize that a baseline altered brain functional and neural connectivity might determine the vulnerability signature for incipient overall system disruption in presence of acute insults. Conclusions and implications: Eventually, our findings moved a step forward in supporting the key importance of routine screening for sensory impairments and cognitive status of older patients for the highest risk of in-hospital delirium. In fact, preventive interventions could be particularly relevant and effective in preventing delirium in such vulnerable populations and might help refining this early diagnosis

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017.

Introduction: Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium. Methods: The analyses were conducted employing the cross-sectional "Delirium Day" initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses. Results: A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09-2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001]. Discussion and conclusion: Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Introduction Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium. Methods The analyses were conducted employing the cross-sectional "Delirium Day" initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference <= 34 cm in males and <= 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses. Results A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09-2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001]. Discussion and conclusion Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium

The relationship between frailty and delirium: insights from the 2017 Delirium Day study.

Background: although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality. Objective: to examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect these patients' 30-day survival. Design: observational study nested in the Delirium Day project, with 30-day follow-up. Setting: acute medical wards (n = 118) and rehabilitation wards (n = 46) in Italy. Subjects: a total of 2,065 individuals aged 65+ years hospitalized in acute medical (1,484 patients, 71.9%) or rehabilitation (581 patients, 28.1%) wards. Methods: a 25-item Frailty Index (FI) was created. Delirium was assessed using the 4AT test. Vital status was ascertained at 30 days. Results: overall, 469 (22.7%) patients experienced delirium on the index day and 82 (4.0%) died during follow-up. After adjustment for potential confounders, each FI score increase of 0.1 significantly increased the odds of delirium (odds ratio, OR: 1.66 [95% CI: 1.45-1.90]), with no difference between the acute (OR: 1.65 [95% CI: 1.41-1.93]) and rehabilitation ward patients (OR: 1.71 [95% CI: 1.27-2.30]). The risk of dying during follow-up also increased significantly for every FI increase of 0.1 in the overall population (OR: 1.65 [95% CI: 1.33-2.05]) and in the acute medical ward patients (OR: 1.61 [95% CI: 1.28-2.04]), but not in the rehabilitation patients. Delirium was not significantly associated with 30-day mortality in either hospital setting. Conclusions: in hospitalized older patients, frailty is associated with delirium and with an increased risk of short-term mortality

Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study

426noreservedObjective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 “Delirium Day” project. Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P <.001), visual impairment (24.2% vs 15.7%; P <.01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2–2.1; P =.00] and in Model 2 (OR 1.4; CI 1.1–1.9; P =.02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6–1.2, P =.36; OR 1.1; CI 0.8–1.4; P =.42) or in Model 2 (OR 0.8, CI 0.6–1.2, P =.27; OR 1.1, CI 0.8–1.4, P =.63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.mixedMorandi A.; Inzitari M.; Udina C.; Gual N.; Mota M.; Tassistro E.; Andreano A.; Cherubini A.; Gentile S.; Mossello E.; Marengoni A.; Olive A.; Riba F.; Ruiz D.; de Jaime E.; Bellelli G.; Tarasconi A.; Sella M.; Auriemma S.; Paterno G.; Faggian G.; Lucarelli C.; De Grazia N.; Alberto C.; Margola A.; Porcella L.; Nardiello I.; Chimenti E.; Zeni M.; Giani A.; Famularo S.; Romairone E.; Minaglia C.; Ceccotti C.; Guerra G.; Mantovani G.; Monacelli F.; Candiani T.; Ballestrero A.; Santolini F.; Rosso M.; Bono V.; Sibilla S.; Dal Santo P.; Ceci M.; Barone P.; Schirinzi T.; Formenti A.; Nastasi G.; Isaia G.; Gonella D.; Battuello A.; Casson S.; Calvani D.; Boni F.; Ciaccio A.; Rosa R.; Sanna G.; Manfredini S.; Cortese L.; Rizzo M.; Prestano R.; Greco A.; Lauriola M.; Gelosa G.; Piras V.; Arena M.; Cosenza D.; Bellomo A.; LaMontagna M.; Gabbani L.; Lambertucci L.; Perego S.; Parati G.; Basile G.; Gallina V.; Pilone G.; Giudice C.; De F.; Pietrogrande L.; De B.; Mosca M.; Corazzin I.; Rossi P.; Nunziata V.; D'Amico F.; Grippa A.; Giardini S.; Barucci R.; Cossu A.; Fiorin L.; Distefano M.; Lunardelli M.; Brunori M.; Ruffini I.; Abraham E.; Varutti A.; Fabbro E.; Catalano A.; Martino G.; Leotta D.; Marchet A.; Dell'Aquila G.; Scrimieri A.; Davoli M.; Casella M.; Cartei A.; Polidori G.; Brischetto D.; Motta S.; Saponara R.; Perrone P.; Russo G.; Del D.; Car C.; Pirina T.; Franzoni S.; Cotroneo A.; Ghiggia F.; Volpi G.; Menichetti C.; Bo M.; Panico A.; Calogero P.; Corvalli G.; Mauri M.; Lupia E.; Manfredini R.; Fabbian F.; March A.; Pedrotti M.; Veronesi M.; Strocchi E.; Borghi C.; Bianchetti A.; Crucitti A.; DiFrancesco V.; Fontana G.; Bonanni L.; Barbone F.; Serrati C.; Ballardini G.; Simoncelli M.; Ceschia G.; Scarpa C.; Brugiolo R.; Fusco S.; Ciarambino T.; Biagini C.; Tonon E.; Porta M.; Venuti D.; DelSette M.; Poeta M.; Barbagallo G.; Trovato G.; Delitala A.; Arosio P.; Reggiani F.; Zuliani G.; Ortolani B.; Mussio E.; Girardi A.; Coin A.; Ruotolo G.; Castagna A.; Masina M.; Cimino R.; Pinciaroli A.; Tripodi G.; Cannistra U.; Cassadonte F.; Vatrano M.; Scaglione L.; Fogliacco P.; Muzzuilini C.; Romano F.; Padovani A.; Rozzini L.; Cagnin A.; Fragiacomo F.; Desideri G.; Liberatore E.; Bruni A.; Orsitto G.; Franco M.; Bonfrate L.; Bonetto M.; Pizio N.; Magnani G.; Cecchetti G.; Longo A.; Bubba V.; Marinan L.; Cotelli M.; Turla M.; Sessa M.; Abruzzi L.; Castoldi G.; LoVetere D.; Musacchio C.; Novello M.; Cavarape A.; Bini A.; Leonardi A.; Seneci F.; Grimaldi W.; Fimognari F.; Bambara V.; Saitta A.; Corica F.; Braga M.; Ettorre E.; Camellini C.; Bellelli G.; Annoni G.; Crescenzo A.; Noro G.; Turco R.; Ponzetto M.; Giuseppe L.; Mazzei B.; Maiuri G.; Costaggiu D.; Damato R.; Formilan M.; Patrizia G.; Gallucci M.; Paragona M.; Bini P.; Modica D.; Abati C.; Clerici M.; Barbera I.; NigroImperiale F.; Manni A.; Votino C.; Castiglioni C.; Di M.; Degl'Innocenti M.; Moscatelli G.; Guerini S.; Casini C.; Dini D.; D'Imporzano E.; DeNotariis S.; Bonometti F.; Paolillo C.; Riccardi A.; Tiozzo A.; DiBari M.; Vanni S.; Scarpa A.; Zara D.; Ranieri P.; Alessandro M.; Di F.; Pezzoni D.; Platto C.; D'Ambrosio V.; Ivaldi C.; Milia P.; DeSalvo F.; Solaro C.; Strazzacappa M.; Cazzadori M.; Confente S.; Grasso M.; Troisi E.; Guerini V.; Bernardini B.; Corsini C.; Boffelli S.; Filippi A.; Delpin K.; Faraci B.; Bertoletti E.; Vannucci M.; Tesi F.; Crippa P.; Malighetti A.; Bettini D.; Maltese F.; Abruzzese G.; Cosimo D.; Azzini M.; Colombo M.; Procino G.; Fascendini S.; Barocco F.; Del P.; Mazzone A.; Riva E.; Dell'Acqua D.; Cottino M.; Vezzadini G.; Avanzi S.; Brambilla C.; Orini S.; Sgrilli F.; Mello A.; Lombardi L.; Muti E.; Dijk B.; Fenu S.; Pes C.; Gareri P.; Passamonte M.; Rigo R.; Locusta L.; Caser L.; Rosso G.; Cesarini S.; Cozzi R.; Santini C.; Carbone P.; Cazzaniga I.; Lovati R.; Cantoni A.; Ranzani P.; Barra D.; Pompilio G.; Dimori S.; Cernesi S.; Ricco C.; Piazzolla F.; Capittini E.; Rota C.; Gottardi F.; Merla L.; Barelli A.; Millul A.; De G.; Morrone G.; Bigolari M.; Macchi M.; Zambon F.; Pizzorni C.; DiCasaleto G.; Menculini G.; Marcacci M.; Catanese G.; Sprini D.; DiCasalet T.; Bocci M.; Borga S.; Caironi P.; Cat C.; Cingolani E.; Avalli L.; Greco G.; Citerio G.; Gandini L.; Cornara G.; Lerda R.; Brazzi L.; Simeone F.; Caciorgna M.; Alampi D.; Francesconi S.; Beck E.; Antonini B.; Vettoretto K.; Meggiolaro M.; Garofalo E.; Notaro S.; Varutti R.; Bassi F.; Mistraletti G.; Marino A.; Rona R.; Rondelli E.; Riva I.; Scapigliati A.; Cortegiani A.; Vitale F.; Pistidda L.; D'Andrea R.; Querci L.; Gnesin P.; Todeschini M.; Lugano M.; Castelli G.; Ortolani M.; Cotoia A.; Maggiore S.; DiTizio L.; Graziani R.; Testa I.; Ferretti E.; Castioni C.; Lombardi F.; Caserta R.; Pasqua M.; Simoncini S.; Baccarini F.; Rispoli M.; Grossi F.; Cancelliere L.; Carnelli M.; Puccini F.; Biancofiore G.; Siniscalchi A.; Laici C.; Mossello E.; Torrini M.; Pasetti G.; Palmese S.; Oggioni R.; Mangani V.; Pini S.; Martelli M.; Rigo E.; Zuccala F.; Cherri A.; Spina R.; Calamai I.; Petrucci N.; Caicedo A.; Ferri F.; Gritti P.; Brienza N.; Fonnesu R.; Dessena M.; Fullin G.; Saggioro D.Morandi, A.; Inzitari, M.; Udina, C.; Gual, N.; Mota, M.; Tassistro, E.; Andreano, A.; Cherubini, A.; Gentile, S.; Mossello, E.; Marengoni, A.; Olive, A.; Riba, F.; Ruiz, D.; de Jaime, E.; Bellelli, G.; Tarasconi, A.; Sella, M.; Auriemma, S.; Paterno, G.; Faggian, G.; Lucarelli, C.; De Grazia, N.; Alberto, C.; Margola, A.; Porcella, L.; Nardiello, I.; Chimenti, E.; Zeni, M.; Giani, A.; Famularo, S.; Romairone, E.; Minaglia, C.; Ceccotti, C.; Guerra, G.; Mantovani, G.; Monacelli, F.; Candiani, T.; Ballestrero, A.; Santolini, F.; Rosso, M.; Bono, V.; Sibilla, S.; Dal Santo, P.; Ceci, M.; Barone, P.; Schirinzi, T.; Formenti, A.; Nastasi, G.; Isaia, G.; Gonella, D.; Battuello, A.; Casson, S.; Calvani, D.; Boni, F.; Ciaccio, A.; Rosa, R.; Sanna, G.; Manfredini, S.; Cortese, L.; Rizzo, M.; Prestano, R.; Greco, A.; Lauriola, M.; Gelosa, G.; Piras, V.; Arena, M.; Cosenza, D.; Bellomo, A.; Lamontagna, M.; Gabbani, L.; Lambertucci, L.; Perego, S.; Parati, G.; Basile, G.; Gallina, V.; Pilone, G.; Giudice, C.; De, F.; Pietrogrande, L.; De, B.; Mosca, M.; Corazzin, I.; Rossi, P.; Nunziata, V.; D'Amico, F.; Grippa, A.; Giardini, S.; Barucci, R.; Cossu, A.; Fiorin, L.; Distefano, M.; Lunardelli, M.; Brunori, M.; Ruffini, I.; Abraham, E.; Varutti, A.; Fabbro, E.; Catalano, A.; Martino, G.; Leotta, D.; Marchet, A.; Dell'Aquila, G.; Scrimieri, A.; Davoli, M.; Casella, M.; Cartei, A.; Polidori, G.; Brischetto, D.; Motta, S.; Saponara, R.; Perrone, P.; Russo, G.; Del, D.; Car, C.; Pirina, T.; Franzoni, S.; Cotroneo, A.; Ghiggia, F.; Volpi, G.; Menichetti, C.; Bo, M.; Panico, A.; Calogero, P.; Corvalli, G.; Mauri, M.; Lupia, E.; Manfredini, R.; Fabbian, F.; March, A.; Pedrotti, M.; Veronesi, M.; Strocchi, E.; Borghi, C.; Bianchetti, A.; Crucitti, A.; Difrancesco, V.; Fontana, G.; Bonanni, L.; Barbone, F.; Serrati, C.; Ballardini, G.; Simoncelli, M.; Ceschia, G.; Scarpa, C.; Brugiolo, R.; Fusco, S.; Ciarambino, T.; Biagini, C.; Tonon, E.; Porta, M.; Venuti, D.; Delsette, M.; Poeta, M.; Barbagallo, G.; Trovato, G.; Delitala, A.; Arosio, P.; Reggiani, F.; Zuliani, G.; Ortolani, B.; Mussio, E.; Girardi, A.; Coin, A.; Ruotolo, G.; Castagna, A.; Masina, M.; Cimino, R.; Pinciaroli, A.; Tripodi, G.; Cannistra, U.; Cassadonte, F.; Vatrano, M.; Scaglione, L.; Fogliacco, P.; Muzzuilini, C.; Romano, F.; Padovani, A.; Rozzini, L.; Cagnin, A.; Fragiacomo, F.; Desideri, G.; Liberatore, E.; Bruni, A.; Orsitto, G.; Franco, M.; Bonfrate, L.; Bonetto, M.; Pizio, N.; Magnani, G.; Cecchetti, G.; Longo, A.; Bubba, V.; Marinan, L.; Cotelli, M.; Turla, M.; Sessa, M.; Abruzzi, L.; Castoldi, G.; Lovetere, D.; Musacchio, C.; Novello, M.; Cavarape, A.; Bini, A.; Leonardi, A.; Seneci, F.; Grimaldi, W.; Fimognari, F.; Bambara, V.; Saitta, A.; Corica, F.; Braga, M.; Ettorre, E.; Camellini, C.; Bellelli, G.; Annoni, G.; Crescenzo, A.; Noro, G.; Turco, R.; Ponzetto, M.; Giuseppe, L.; Mazzei, B.; Maiuri, G.; Costaggiu, D.; Damato, R.; Formilan, M.; Patrizia, G.; Gallucci, M.; Paragona, M.; Bini, P.; Modica, D.; Abati, C.; Clerici, M.; Barbera, I.; Nigroimperiale, F.; Manni, A.; Votino, C.; Castiglioni, C.; Di, M.; Degl'Innocenti, M.; Moscatelli, G.; Guerini, S.; Casini, C.; Dini, D.; D'Imporzano, E.; Denotariis, S.; Bonometti, F.; Paolillo, C.; Riccardi, A.; Tiozzo, A.; Dibari, M.; Vanni, S.; Scarpa, A.; Zara, D.; Ranieri, P.; Alessandro, M.; Di, F.; Pezzoni, D.; Platto, C.; D'Ambrosio, V.; Ivaldi, C.; Milia, P.; Desalvo, F.; Solaro, C.; Strazzacappa, M.; Cazzadori, M.; Confente, S.; Grasso, M.; Troisi, E.; Guerini, V.; Bernardini, B.; Corsini, C.; Boffelli, S.; Filippi, A.; Delpin, K.; Faraci, B.; Bertoletti, E.; Vannucci, M.; Tesi, F.; Crippa, P.; Malighetti, A.; Bettini, D.; Maltese, F.; Abruzzese, G.; Cosimo, D.; Azzini, M.; Colombo, M.; Procino, G.; Fascendini, S.; Barocco, F.; Del, P.; Mazzone, A.; Riva, E.; Dell'Acqua, D.; Cottino, M.; Vezzadini, G.; Avanzi, S.; Brambilla, C.; Orini, S.; Sgrilli, F.; Mello, A.; Lombardi, L.; Muti, E.; Dijk, B.; Fenu, S.; Pes, C.; Gareri, P.; Passamonte, M.; Rigo, R.; Locusta, L.; Caser, L.; Rosso, G.; Cesarini, S.; Cozzi, R.; Santini, C.; Carbone, P.; Cazzaniga, I.; Lovati, R.; Cantoni, A.; Ranzani, P.; Barra, D.; Pompilio, G.; Dimori, S.; Cernesi, S.; Ricco, C.; Piazzolla, F.; Capittini, E.; Rota, C.; Gottardi, F.; Merla, L.; Barelli, A.; Millul, A.; De, G.; Morrone, G.; Bigolari, M.; Macchi, M.; Zambon, F.; Pizzorni, C.; Dicasaleto, G.; Menculini, G.; Marcacci, M.; Catanese, G.; Sprini, D.; Dicasalet, T.; Bocci, M.; Borga, S.; Caironi, P.; Cat, C.; Cingolani, E.; Avalli, L.; Greco, G.; Citerio, G.; Gandini, L.; Cornara, G.; Lerda, R.; Brazzi, L.; Simeone, F.; Caciorgna, M.; Alampi, D.; Francesconi, S.; Beck, E.; Antonini, B.; Vettoretto, K.; Meggiolaro, M.; Garofalo, E.; Notaro, S.; Varutti, R.; Bassi, F.; Mistraletti, G.; Marino, A.; Rona, R.; Rondelli, E.; Riva, I.; Scapigliati, A.; Cortegiani, A.; Vitale, F.; Pistidda, L.; D'Andrea, R.; Querci, L.; Gnesin, P.; Todeschini, M.; Lugano, M.; Castelli, G.; Ortolani, M.; Cotoia, A.; Maggiore, S.; Ditizio, L.; Graziani, R.; Testa, I.; Ferretti, E.; Castioni, C.; Lombardi, F.; Caserta, R.; Pasqua, M.; Simoncini, S.; Baccarini, F.; Rispoli, M.; Grossi, F.; Cancelliere, L.; Carnelli, M.; Puccini, F.; Biancofiore, G.; Siniscalchi, A.; Laici, C.; Mossello, E.; Torrini, M.; Pasetti, G.; Palmese, S.; Oggioni, R.; Mangani, V.; Pini, S.; Martelli, M.; Rigo, E.; Zuccala, F.; Cherri, A.; Spina, R.; Calamai, I.; Petrucci, N.; Caicedo, A.; Ferri, F.; Gritti, P.; Brienza, N.; Fonnesu, R.; Dessena, M.; Fullin, G.; Saggioro, D

Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study

Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium

Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

Background: Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. Aim: We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project". Methods: We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. Results: Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001). Conclusion: This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium